Organization
BLACKS FORK DENTAL, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NATHAN REN LESTER DMD (PRESIDENT)
(307) 782-3630
Entity
Organization
Contact information
Practice address
650 PARKWAY DR, MT VIEW, WY 82939
(307) 782-3630
Mailing address
PO BOX 356, MOUNTAIN VIEW, WY 82939-0356
(307) 782-3630
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
02/13/2019
Last updated
02/13/2019
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